Each year in the U.S. over 250,000 ventilated patients in the intensive care unit contract Ventilator-associated pneumonia (VAP), a hospital-acquired infection which has captured the attention of numerous stakeholders in the critical care domain. VAP has a 30% mortality rate1,2 and results in an extended ICU stay of 4.3 days1,2,3,4, on average. Hospitals incur an additional $40,000 in incremental costs3 per patient, and a national average of Reducing the incidence of Ventilator-associated pneumonia (VAP) and $10 Billion is spent on VAP annually3,16. related ventilator-associated events (VAE) is of prime importance to clinicians, hospital stakeholders, accrediting agencies and ultimately patients. However, despite evidence that maintaining ventilated patients at an elevation between 30-45 degrees is correlated with significantly improved VAP outcomes3,6,10,12, there is currently a dearth of effective methods for accurately and efficiently measuring a patient's elevation in real time. Existing tools for measuring patient elevation are archaic, inflexible and unreliable. Without accurate, reliable and available data on a patient's elevation, evaluating and improving compliance with head of bed guidelines is challenging to say the least. A mechanism that accurately measures a patient's elevation and signals that information to nurses is highly desired, and can dramatically improve compliance with best-practice patient-elevation guidelines, which in turn would reduce the incidence of VAP, shorten ICU stays and translate into tremendous cost savings and improved clinical outcomes for hospitals. Angulus was developed to fill this gap in critical care technology. It is a novel sensor, which accurately measures patient elevation in real time - irrespective of a patient's idiosyncratic orientation - and transmits on-demand minute-to-minute data and aggregate trends to a corresponding display device via Bluetooth. Angulus is composed of two components - a wireless sensor which is affixed to the patient's sternum, and a corresponding software interface, which displays the patient elevation angle. Utilization of Angulus will empower critical care treatment teams to more efficiently monitor patients' elevation, and improve compliance to HOB guidelines. In this Phase I proposal we will collaborate with Albert Einstein/ Montefiore Medical center to: 1) conduct initil end-user focus groups, 2) validate the accuracy of Angulus as a patient elevation measurement tool, 3) implement a randomized cross over trial to measure the impact of Angulus on improving compliance with patient elevation guidelines, and 4) collect end-user satisfaction and usability scores and integrate critical functionality with an agile and iterative product development approach. By empowering critical care teams with intelligible, accessible and accurate on demand data about a patient's elevation angle in real time, Angulus will improve compliance with patient elevation guidelines. This work will have a tremendous impact on resolving a burdensome problem associated with increased patient morbidity and astronomical costs. This proposal is very highly aligned with the overall mission of NHLBI.